Short- and Long-Term Prognosis of COVID-19-Associated Versus Non-COVID-19 Takotsubo Cardiomyopathy: A Propensity-Matched Nationwide Study

BACKGROUND: Takotsubo cardiomyopathy (TCM) is a stress-induced cardiomyopathy with transient left ventricular dysfunction, often triggered by acute illness. Coronavirus disease 2019 (COVID-19) has been implicated as a precipitant, but comparative outcome data for COVID-19-related versus non-COVID-19 TCM remain largely limited to the early pandemic, when few effective treatments existed. METHODS: We conducted a retrospective cohort study using the TriNetX database, identifying US adults hospitalized between March 2020 and March 2025 with TCM and created two cohorts: patients with TCM and laboratory-confirmed COVID-19 and patients with TCM without COVID-19, both diagnosed within 14 days of admission. The primary outcome was 30-day all-cause mortality, with secondary 30-day outcomes and one-year mortality also assessed. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. RESULTS: Of 16,649 patients (6,367 COVID-19 TCM and 10,282 non-COVID-19 TCM), 5,955 per group remained after propensity score matching. Baseline demographics and comorbidities were well balanced (mean age 66.8 years; 76.8% female). Thirty-day mortality did not differ significantly between COVID-19 and non-COVID-19 TCM (12.0% vs. 11.1%; HR 1.07, 95% CI 0.97-1.19). However, COVID-19 TCM was associated with higher risks of heart failure with reduced ejection fraction (HFrEF) (HR 1.18, 95% CI 1.10-1.26), cardiogenic shock (HR 1.25, 95% CI 1.08-1.46), and ventricular arrhythmias (HR 1.37, 95% CI 1.14-1.64). One-year mortality was significantly higher in the COVID-19 cohort (22.0% vs. 18.3%; HR 1.19, 95% CI 1.10-1.29). CONCLUSION: COVID-19-associated TCM is not linked to excess short-term mortality but carries higher risks of acute complications and significantly worse one-year survival, highlighting the persistent effects of COVID-19 after an acute infection.